Cardiac damage in athlete’s heart: When the “supernormal” heart fails!

Table 1 Differences in between physiological and pathological hypertrophy

Physiological hypertrophy	Pathological hypertrophy
Angiogenesis, release of VEGF	Perivascular fibrosis and inflammation
Activation of IGF-1 pathway (IGF-1- > PI3K- > Akt)	Activation of Angiotensin II, Catecholamine and Endotelin-1
No fibrosis	MAPK and Calcineurin pathway
Normal gene expression	Fibrosis, myocyte necrosis and apoptosis
Proportional chamber enlargement	Cardiac dysfunction

The table summarizes the differences in the cellular and molecular pattern between physiological and pathological hypertrophy. VEGF: Vascular endothelial growth factor; IGF-1: Insulin like growth factor; PI3K: Phosphoinositide 3-kinase; MAPK: Mitogen-activated protein kinase.

Table 2 Pathological mechanisms of atrial fibrillation in long-term athletes

Pathological mechanism
Atrial ectopic beats
Vagal nervous system
Atrial fibrosis
Atrial dilatation
Myocardial injury
Inflammation
Redox imbalance

The table shows the most important mechanisms involved in atrial fibrillation exercise related.

Table 3 Indicators of right ventricle pathology

Episodes of syncope

> 1000 ventricular extra-systoles (or > 500 non-RV outflow tract) per 24 h; ventricular tachyarrhythmias; Q waves in precordial leads; augmented QRS duration

≥ 3 abnormal signal averaged electrocardiography parameters

Delayed gadolinium enhancement; RV ejection fraction < 45%, or wall motion abnormalities at CMRI; impaired RV strain imaging

Attenuated blood pressure response during exercise

Dilatation of RV outflow tract

The table shows the indicators of right ventricle pathology (ARVC vs athlete’s heart). CMRI: Cardiac magnetic resonance imaging; RV: Right ventricle; ARVC: Arrhythmogenic right ventricular cardiomyopathy.

Table 4 Adverse effects of energy drinks

Adverse effect
Hypertension
Palpitations/arrhythmias (atrial fibrillation)
QTc prolongation
Myocardial ischemia
Ischemic stroke/Transient ischemic attack
Epileptic seizure
Anxiety, insomnia, irritability
Psychosis/Mania

The table shows the most common adverse effect of consumption of energy drinks.